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Diastolic function in children with Kawasaki disease
Elif Seda Selamet Tierney1, Jane W Newburger, Dionne Graham
1Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, MA 02155, United States. Seda.Tierney@cardio.chboston.org
Insights
Kawasaki Disease (KD) patients show impaired diastolic function, especially early after treatment and in those with coronary artery dilation (CAD). This suggests early detection and management are crucial for KD complications.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Coronary artery dilation (CAD) and left ventricular systolic dysfunction are known complications of Kawasaki Disease (KD).
- Diastolic function in KD patients, its relation to disease course, systolic dysfunction, and CAD is not well understood.
- Echocardiography is a key tool for assessing cardiac function in KD.
Purpose of the Study:
- To investigate diastolic function in Kawasaki Disease (KD) patients.
- To identify clinical correlates of impaired diastolic function in KD.
- To assess the impact of coronary artery dilation (CAD) on diastolic function in KD.
Main Methods:
- Analysis of echocardiogram tissue Doppler velocities in KD patients.
- Categorization of patients into groups based on the presence (Group I) or absence (Group II) of CAD.
- Comparison of diastolic function parameters between early (0-30 days) and late (>30 days) post-IVIG treatment periods.
Main Results:
- 116 KD patients were included; 36% developed CAD.
- KD patients with CAD exhibited reduced lateral mitral annular early diastolic velocity (E') and prolonged deceleration time compared to those without CAD.
- Early post-IVIG treatment (0-30 days) was associated with decreased E' (lateral and septal) compared to later periods.
Conclusions:
- Impaired diastolic relaxation is evident in Kawasaki Disease (KD) patients.
- Diastolic dysfunction is more pronounced in KD patients with coronary artery dilation (CAD).
- Early detection of diastolic dysfunction in KD, particularly in the early post-treatment phase and in patients with CAD, is clinically significant.
Background:
Coronary artery dilation (CAD) and left ventricular systolic dysfunction are recognized complications of Kawasaki Disease (KD). Diastolic function assessed by echocardiography in the KD patient population and its interrelationship to the KD course, systolic dysfunction, and CAD is less well characterized. The purpose of this study was to determine whether diastolic function is impaired in KD patients and whether there are any clinical correlates.
Design/Methods:
All KD patients with an echocardiogram recording of tissue Doppler velocities were included. Patients were analyzed based on CAD (Group I: patients who had CAD during their disease course; Group II: patients who never had CAD). In addition, we compared measures of diastolic function in patients with echocardiograms 0-30 days (n=35) and >30 days (n=72) post-IVIG treatment.
Results:
116 patients (80 males) were included (mean age, 7.7±6.7 years; mean time since KD onset, 4.0±5.6 years). Group I (41 patients, 36%), compared to Group II, had decreased E'(lateral) and longer mitral early deceleration time. E'(lateral) and E'(septal) were significantly decreased in patients 0-30 days vs. >30 days post-IVIG, whereas mitral early deceleration time was not significantly different.
Conclusion:
Our results demonstrate that there is impaired relaxation in KD patients in the early phase of the disease and in KD patients with CAD during the disease course.
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